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Bleton JP, Portero R, Zuber K, Sangla S, Brandel JP, Vidailhet M, Mesure S, Williams M, Savatovsky J. Assessment of axial rotation movement in cervical dystonia using cone-beam computed tomography. Clin Biomech (Bristol, Avon) 2023; 107:106037. [PMID: 37429102 DOI: 10.1016/j.clinbiomech.2023.106037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Cervical dystonia is a neurological disorder characterized by involuntary muscle contractions and abnormal postures of the head and neck. Botulinum neurotoxin injection is the first-line treatment. Imaging determination of the cervical segments involved (lower or upper according to the torticollis-torticaput [COL-CAP] Classification) is an aid in determining the muscles to be injected. We aimed to clarify the impact of dystonia on posture and rotational movement of cervical vertebrae in the transverse plane. METHODS A comparative study was conducted in a movement disorders department. Ten people with cervical dystonia and 10 matched healthy subjects (without cervical dystonia) were recruited. 3-D images of posture and cervical range of motion in axial rotation in the sitting position were recorded by using a cone-beam CT scanner. Range of rotational motion of the upper cervical spine from the occipital bone to fourth cervical vertebra was measured and compared between the two groups. FINDINGS The head posture analysis showed that the total cervical spine position was more significantly distant from the neutral position for people with dystonia than healthy subjects (p = 0.007). The rotational range of motion of the cervical spine was significantly lower in cervical dystonia participants than in healthy subjects for the total (p = 0.026) and for upper cervical spine (p = 0.004). INTERPRETATION We demonstrated, by means of cone-beam CT, that the disorganization of movements due to cervical dystonia affected the upper cervical spine and mostly the atlantoaxial joint. The involvement of rotator muscles at this cervical level should be considered more in treatments.
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Affiliation(s)
- Jean-Pierre Bleton
- Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France; Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France.
| | - Raphaël Portero
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Kévin Zuber
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Sophie Sangla
- Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Marie Vidailhet
- Sorbonne Université, F-75005 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l'Hôpital, F-75013 Paris, France; Inserm U1127, CNRS UMR 7225, UM 75, ICM, F-75013 Paris, France
| | - Serge Mesure
- Aix-Marseille University, CNRS, ISM UMR 7287, F-13288 Marseille, France
| | - Marc Williams
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Julien Savatovsky
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France
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Santos-Paz JA, Sánchez-Picot Á, Rojo A, Martín-Pintado-Zugasti A, Otero A, Garcia-Carmona R. A novel virtual reality application for autonomous assessment of cervical range of motion: development and reliability study. PeerJ 2022; 10:e14031. [PMID: 36124134 PMCID: PMC9482359 DOI: 10.7717/peerj.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background Neck pain, one of the most common musculoskeletal diseases, affects 222 million people worldwide. The cervical range of motion (CROM) is a tool used to assess the neck's state across three movement axes: flexo-extension, rotation, and lateral flexion. People with neck pain often have a reduced CROM, and they feel pain at the end-range and/or accompany neck movements with compensatory trunk movements. Virtual reality (VR) setups can track the movement of the head and other body parts in order to create the sensation of immersion in the virtual environment. Using this tracking position information, a CROM assessment can be performed using a VR setup that may be carried out autonomously from the user's home. The objectives of this study were to develop a VR experience that could be used to perform a CROM assessment, and to evaluate the intra-rater and inter-rater reliability of the CROM measures guided by this VR experience. To the best of our knowledge, a study of this type has not been carried out before. Materials & Methods A total of 30 asymptomatic adults were assessed using a VR device (HTC Vive Pro Eye™). Two raters provided support with the VR setup, and the participants were guided by the VR experience as they performed the movements. Each rater tested each subject twice, in random order. In addition to a head-mounted display (HMD), a tracker located on the subject's back was used to measure trunk compensatory movements. The CROM was estimated using only the HMD position and this measurement was corrected using the tracker data. The mean and standard deviation were calculated to characterize the CROM. To evaluate the reliability, the interclass correlation coefficients (ICC) were calculated for intra-rater and inter-rater analysis. The standard error of measurement and minimum detectable change were also calculated. The usability of the VR system was measured using the Spanish version of the System Usability Scale. Results The mean CROM values in each axis of movement were compatible with those described in the literature. ICC values ranged between 0.86 and 0.96 in the intra-rater analysis and between 0.83 and 0.97 in the inter-rater analysis; these values were between good and excellent. When applying the correction of the trunk movements, both the intra-rater and inter-rater ICC values slightly worsened except in the case of the lateral flexion movement, where they slightly improved. The usability score of the CROM assessment/VR system was 86 points, which is an excellent usability score. Conclusion The reliability of the measurements and the usability of the system indicate that a VR setup can be used to assess CROM. The reliability of the VR setup can be affected by slippage of the HMD or tracker. Both slippage errors are additive, i.e., only when the sum of these two errors is less than the compensatory movement do the measurements improve when considering the tracker data.
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Affiliation(s)
- Jose Angel Santos-Paz
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Álvaro Sánchez-Picot
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Ana Rojo
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | | | - Abraham Otero
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Rodrigo Garcia-Carmona
- Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
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Muth-Seng C, Huneidi M, Heidsieck C, Laporte S, Le Coz JY, Gille O, Skalli W. Personalised gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position. Clin Biomech (Bristol, Avon) 2022; 92:105577. [PMID: 35042094 DOI: 10.1016/j.clinbiomech.2022.105577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND As a leading cause of disability with a high societal and economic cost, it is crucial to better understand risk factors of neck pain and surgical complications. Getting subject-specific external loading is essential for quantifying muscle forces and joint loads but it requires exertion trials and load cells which are uncommon in clinical settings. METHODS This paper presents a method to compute the gravitational loading at four levels of the cervical spine (C3C4, C4C5, C5C6, C6C7) in neutral standing position from biplanar radiographs exclusively. The resulting load was decomposed in local disc frames and its components were used to compare different populations: 118 asymptomatic subjects and 46 patients before and after surgery (anterior cervical discectomy and fusion or total disc replacement). Comparisons were performed at C6C7 and the upper level adjacent to surgery. FINDINGS Significant changes in gravitational loading were observed with age in healthy subjects as well as in patients after surgery and have been associated with changes in posture. INTERPRETATION This approach quantifies the influence of postural changes on gravitational loading on the cervical spine. It represents a simple way to obtain necessary input for muscle force quantification models in clinical routine and to use them for patient evaluation. The study of the subsequent subject-specific spinal loading could help further the understanding of cervical spine biomechanics, degeneration mechanisms and complications following surgery.
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Affiliation(s)
- Christophe Muth-Seng
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France.
| | - Maxime Huneidi
- Service de chirurgie orthopédique et traumatologique, Groupe Hospitalier Pellegrin, CHU de Bordeaux, Bordeaux 33076, France
| | - Cécile Heidsieck
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Sébastien Laporte
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Jean-Yves Le Coz
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
| | - Olivier Gille
- Service de chirurgie orthopédique et traumatologique, Groupe Hospitalier Pellegrin, CHU de Bordeaux, Bordeaux 33076, France
| | - Wafa Skalli
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, IBHGC - Institut de Biomécanique Humaine Georges Charpak, HESAM Université, F-75013, Paris, France
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Chuang HC, Tseng YH, Chen Y, Chou PH, Chang WL, Su PF, Lin CL. Assessment of sagittal spinopelvic parameters in a Taiwanese population with spondylolysis by the EOS imaging system: a retrospective radiological analysis. BMC Musculoskelet Disord 2021; 22:553. [PMID: 34144702 PMCID: PMC8214289 DOI: 10.1186/s12891-021-04440-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background The impact of sagittal spinopelvic alignment on spondylolysis is well established in Caucasian populations. However, prior studies suggest that people from different ethnological backgrounds showed divergence, and a few studies that focused on Asian populations reported conflicting results. The aim of this study is to use the EOS imaging system to evaluate the spinopelvic parameters of spondylolysis patients, and their relationship with spondylolisthesis, disc degeneration, and age in a Taiwanese population. Methods Radiographic sagittal spinopelvic parameters for 45 spondylolysis patients and 32 healthy people were evaluated, including pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), and lumbar lordosis (LL). The spinopelvic parameters were compared between spondylolytic and control groups. These parameters were further compared between spondylolytic subjects with and without spondylolisthesis, with and without high-grade disc degeneration, and young (< 30 years old) and middle-aged. Results The PI and LL of the spondylolytic group (52.6°±12.0° and 41.3°±15.2°) were significantly higher than those of the healthy control group (47.16°±7.95° and 28.22°±10.65°). Further analysis of the spondylolytic patients revealed that those with high-grade disc degeneration were more prone to spondylolisthesis (92.3 %) compared to those without (50 %; p = 0.001). The middle-aged group had significantly higher rates of spondylolisthesis (80 %) and high-grade disc degeneration (52.4 %) compared with those for the young group (45 and 16.7 %, respectively; p = 0.017 and 0.047, respectively). No statistically significant difference in the sagittal spinopelvic parameters was found when spondylolytic patients were divided according to the occurrence of spondylolisthesis or high-grade disc degeneration. Conclusions In a Taiwanese population, PI and LL were significantly larger in spondylolytic patients. Disc degeneration and age were associated with the occurrence of spondylolisthesis. Ethnological differences should thus be taken into account when making clinical decisions regarding spondylolysis in a Taiwanese population.
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Affiliation(s)
- Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Yu-Hsiang Tseng
- Department of Plastic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Christian Hospital, Tainan, Taiwan
| | - Po-Hsin Chou
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Lun Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan, Taiwan.,Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
| | - Pei-Fang Su
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan, Taiwan. .,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan. .,Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan, Taiwan. .,Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan.
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Tuttle N, Sperotto Dos Santos Rocha C, Sheehan B, Kennedy BA, Evans K. Measurement of three-dimensional cervical segmental kinematics: Reliability of whole vertebrae and facet-based approaches. Musculoskelet Sci Pract 2019; 44:102039. [PMID: 31326331 DOI: 10.1016/j.msksp.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/13/2019] [Accepted: 07/07/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have used orientation and translation of whole-vertebrae to describe three-dimensional cervical segmental kinematics. Describing kinematics using facet joint movement may be more relevant to pathology and effects of interventions but has not been investigated in the cervical spine. This study compared the reliability of two different methods (whole-vertebrae vs facet joint) to evaluate cervical kinematics. METHODS Two healthy adults each had six cervical (C1 to T1) magnetic resonance imaging scans, two each in neutral and left and right rotation. A semi-automated method of segmentation and alignment determined the relative orientation and translation of each whole-vertebrae and translation of each facet joint. Intra-rater and inter-rater reliability was determined using limits of agreement (LOA) with 95% confidence intervals and intraclass correlation coefficients (ICC3,1 for intra- and ICC2,1 for inter-rater). RESULTS The LOA for intra-rater evaluation of facet movement was superior to whole vertebra translation. Both methods showed excellent intra-rater ICC3,1 (0.80-0.99) and inter-rater ICC2,1 (0.79-0.85) for all variables except for Euler angle for flexion/extension which was good (0.65). Intra-and inter-rater ICCs were better for facet movement than all measures of whole of vertebrae movement except Euler angles of axial rotation where no difference was detected. CONCLUSIONS Measurement of three-dimensional segmental kinematics using either the facet joint or the whole-vertebrae method demonstrated excellent and comparable reliability. These findings support the use of the facet joint method as an option for describing and investigating cervical segmental kinematics.
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Affiliation(s)
- Neil Tuttle
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - Clarice Sperotto Dos Santos Rocha
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Kerrie Evans
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Faculty of Health Sciences, The University of Sydney, Sydney, Australia; Healthia Ltd, Brisbane, Australia
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6
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Experimental analysis of the lower cervical spine in flexion with a focus on facet tracking. J Biomech 2019; 93:220-225. [DOI: 10.1016/j.jbiomech.2019.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/27/2019] [Accepted: 06/25/2019] [Indexed: 11/17/2022]
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Lau LCM, Hung ALH, Chau WW, Hu Z, Kumar A, Lam TP, Chu WCW, Cheng JCY. Sequential spine-hand radiography for assessing skeletal maturity with low radiation EOS imaging system for bracing treatment recommendation in adolescent idiopathic scoliosis: a feasibility and validity study. J Child Orthop 2019; 13:385-392. [PMID: 31489044 PMCID: PMC6701449 DOI: 10.1302/1863-2548.13.190007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The EOS-imaging system is increasingly adopted for clinical follow-up in scoliosis with the advantages of simultaneous biplanar imaging of the spine in an erect position. Skeletal maturity assessment using a hand radiograph is an essential adjunct to spinal radiography in scoliosis follow-up. This study aims at testing the feasibility and validity of a newly proposed EOS workflow with sequential spine-hand radiography for skeletal maturity assessment and bracing recommendation. METHODS EOS spine-hand radiographs from patients with diagnosis of idiopathic scoliosis, including both sexes and an age range of ten to 14 years, were scored using the Thumb Ossification Composite Index (TOCI), Sanders and Risser methods. Intraclass correlation coefficients (ICCs) were calculated for inter/intraobserver agreement and were tested with Cronbach's alpha values. RESULTS In all, 60 EOS-spine hand radiographs selected from subjects with diagnosis of adolescent idiopathic scoliosis (AIS), including 32 male patients (mean age 11.53 years; 10 to 14) and 28 female patients (mean age 11.50 years; 10 to 13) who underwent sequential spine-hand low dose EOS imaging were generated for analysis. The overall interobserver (ICC = 0.997) and intraobserver agreement (α > 0.9) demonstrated excellent agreement for TOCI staging; ICC > 0.994 for both TOCI and Sanders staging comparing traditional digital versus EOS hand radiography; ICC ≥ 0.841 for agreement on bracing recommendation among TOCI versus the Risser and Sanders system. CONCLUSION With the proposed new EOS workflow it was feasible to produce high image quality for skeletal maturity assessment with excellent reliability and validity to inform consistent bracing recommendation in AIS. The workflow is applicable for busy daily clinic settings in tertiary scoliosis centres with reduced time cost, improved efficiency and throughput of the radiology department. LEVEL OF EVIDENCE III.
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Affiliation(s)
- L. C. M. Lau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - A. L. H. Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - W. W. Chau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Z. Hu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - A. Kumar
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - T. P. Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - W. C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
| | - J. C. Y. Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong,Correspondence should be sent to J. C. Y. Cheng, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T. Hong Kong. E-mail:
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Interrater reliability of three-dimensional reconstruction of the spine. DER ORTHOPADE 2019; 49:350-358. [DOI: 10.1007/s00132-019-03712-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Alzakri A, Vergari C, Van den Abbeele M, Gille O, Skalli W, Obeid I. Global Sagittal Alignment and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis. Spine Deform 2019; 7:236-244. [PMID: 30660217 DOI: 10.1016/j.jspd.2018.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/23/2018] [Accepted: 06/24/2018] [Indexed: 11/18/2022]
Abstract
STUDY DESIGN Case-control study. OBJECTIVES To analyse global sagittal alignment including the cranial center of mass (CCOM) and proximal junctional kyphosis (PJK) in adolescent idiopathic scoliosis (AIS) patients treated with posterior instrumentation. SUMMARY OF BACKGROUND DATA PJK plays an important role in the global sagittal alignment in AIS patients. Maintaining the head above the pelvis allows for a minimization of energy expense in ambulation and upright posture. Numerous studies have been performed to understand the PJK phenomena in AIS patients. However, to our knowledge, no study performed on AIS patients included the head in the analysis of global sagittal alignment and PJK. METHODS This study included 85 AIS patients and 51 asymptomatic adolescents. Low-dose bi-planar radiographs were acquired for each subject preoperatively and at the two-year follow-up. Two global sagittal alignment parameters were calculated, that is, the angle between the vertical and the line joining the center of the bi-coxofemoral axis (HA) and either the most superior point of the dentiform apophysis of C2 (OD) or the cranial center of mass (CCOM). RESULTS Among normal adolescents, the average OD-HA and CCOM-HA angles were -2.3° ± 2° and -1.5° ± 1.8°, respectively. Among AIS patients, the average OD-HA and CCOM-HA angles were, respectively, -2.3° ± 1.9° and -1.3° ± 1.8° preoperatively and -2.8° ± 1.7° and -1.9° ± 1.7° at the last follow-up. Overall, 13% of the patients developed PJK postoperatively. Case-by-case analysis showed that adjusting the thoracic kyphosis and the compensations required to maintain this constant could provide explanatory elements. CONCLUSIONS OD-HA and CCOM-HA angles remain almost constant among the normal group and patients, pre- and postoperatively, whether PJK or non-PJK. Five patients without PJK and only one patient with PJK produced abnormal values relative to the asymptomatic subjects. Therefore, it could be concluded that PJK is a compensation mechanism, which allows for CCOM-HA and, to a lesser extent, OD-HA to remain invariant. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Abdulmajeed Alzakri
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013 Paris, France; Bordeaux University Hospital, Department of Spinal Surgery, Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France; Orthopedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Claudio Vergari
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013 Paris, France
| | - M Van den Abbeele
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013 Paris, France
| | - Olivier Gille
- Bordeaux University Hospital, Department of Spinal Surgery, Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Wafa Skalli
- Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak, 151 bd de l'Hopital, 75013 Paris, France
| | - Ibrahim Obeid
- Bordeaux University Hospital, Department of Spinal Surgery, Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
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Niewiadomski C, Bianco RJ, Afquir S, Evin M, Arnoux PJ. Experimental assessment of cervical ranges of motion and compensatory strategies. Chiropr Man Therap 2019; 27:9. [PMID: 30680090 PMCID: PMC6341704 DOI: 10.1186/s12998-018-0223-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 12/13/2018] [Indexed: 11/17/2022] Open
Abstract
Background Literature is still limited regarding reports of non-invasive assessment of the cervical range of motion in normal subjects. Investigations into compensatory motions, defined as the contribution of an additional direction to the required motion, are also limited. The objectives of this work were to develop and assess a reliable method for measuring the cervical range of motion in order to investigate motion and compensatory strategies. Methods and data collection Ninety-seven no neck-related pain subjects (no severe cervical pathology, 57 women, age: 28.3 ± 7.5y. old, BMI: 22.5 ± 3.2 kg/m2) underwent a non-invasive cervical range of motion assessment protocol. In-vivo head’s motion relative to the thorax was assessed through the measurement of the main angular amplitudes in the 3 directions (flexion/extension, axial rotations and lateral inclinations) and associated compensatory motions using an opto-electronic acquisition system. Results The principal motion reproducibility resulted in intra-class correlation coefficients ranging from 0.81 to 0.86. The following maximum ranges of motion were found: 127.4 ± 15.1° of flexion/extension, 89.3 ± 12° of lateral inclinations and 146.4 ± 13° of axial rotations after 6 outlier exclusions. Compensatory motions highly depend on the associated principal motion: for flexion/extension: (3.5 ± 7.6;-2.1 ± 7.8°), for rotation: (25.7 ± 17.9°;0.4 ± 4.7)°, for inclination: (22.9 ± 34.7°;-0.04 ± 8.7°). Age, BMI and weight significantly correlated with flexions (p < 0.032). Motion patterns were identified through clustering. Conclusions This kinematic analysis has been proven to be a reliable diagnostic tool for the cervical range of motion. The non-unicity and variability of motion patterns through the clustering of motion strategy identification have been shown. Compensatory motions contributed to such motion pattern definition despite presenting significant intra-individual variability.
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Affiliation(s)
- Céline Niewiadomski
- Collège d'Ostéopathie de Provence, Aix en Provence, France.,iLab-Spine - Laboratoire international en imagerie et biomécanique du Rachis, Marseille, France
| | - Rohan-Jean Bianco
- 2iLab Spine - Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR - Aix Marseille Université, Faculté de Médecine secteur-Nord, 51 Bd. P. Dramard, 13015 Marseille, France.,iLab-Spine - Laboratoire international en imagerie et biomécanique du Rachis, Marseille, France
| | - Sanae Afquir
- 2iLab Spine - Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR - Aix Marseille Université, Faculté de Médecine secteur-Nord, 51 Bd. P. Dramard, 13015 Marseille, France.,iLab-Spine - Laboratoire international en imagerie et biomécanique du Rachis, Marseille, France
| | - Morgane Evin
- 2iLab Spine - Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR - Aix Marseille Université, Faculté de Médecine secteur-Nord, 51 Bd. P. Dramard, 13015 Marseille, France.,iLab-Spine - Laboratoire international en imagerie et biomécanique du Rachis, Marseille, France
| | - Pierre-Jean Arnoux
- 2iLab Spine - Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR - Aix Marseille Université, Faculté de Médecine secteur-Nord, 51 Bd. P. Dramard, 13015 Marseille, France.,iLab-Spine - Laboratoire international en imagerie et biomécanique du Rachis, Marseille, France
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Bagheri A, Liu XC, Tassone C, Thometz J, Tarima S. Reliability of Three-Dimensional Spinal Modeling of Patients With Idiopathic Scoliosis Using EOS System. Spine Deform 2019; 6:207-212. [PMID: 29735127 DOI: 10.1016/j.jspd.2017.09.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/25/2017] [Accepted: 09/29/2017] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Three-dimensional (3D) spinal models of children with idiopathic scoliosis (IS) were created using the EOS imaging system (EOS) and sterEOS software. OBJECTIVE To determine the inter- or intraobserver reproducibility of the 3D spinal models in children with IS of different apex locations. SUMMARY OF BACKGROUND DATA 3D spinal model measurements include the Cobb angle, kyphosis, lordosis, and axial vertebral rotation (AVR). Variation of these measurements between two investigators and two different trials by the same investigator were analyzed by inter- and intraclass correlation coefficients (ICCs). METHODS Biplanar radiographic images of 15 patients (age: 6-15 years) with IS were uploaded into the sterEOS software. Spinal and pelvic markers were manually identified to construct a 3D spinal model and measure spinal parameters. Two trained examiners independently performed modeling and performed modeling in spaced out trials. The ICC between inter- and intraobservers were calculated. RESULTS ICCs between inter- and intraobservers were significant for all parameters (p < .05). Both the inter- and intraobservers showed excellent agreement for the Cobb angles in the thoracic segment, kyphosis and lordosis. Substantial interobserver agreement and excellent intraobserver agreement were determined for the Cobb angle in the thoracolumbar or lumbar (TL/L) segment, with less than 6° difference between two raters and less than 2° difference between two trials. Substantial interobserver agreement for the AVR in the TL/L region and substantial interobserver agreement for the AVR in the thoracic region were found, with less than 4° difference between raters. One rater had substantial intraobserver agreement for the AVR in the TL/L region whereas another rater reported moderate to substantial intraobserver agreement in both the thoracic and TL/L regions, with less than 3° difference between trials. CONCLUSION The EOS system shows reliable and repeatable results in 3D spinal modeling of children with IS. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Aria Bagheri
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Xue-Cheng Liu
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Deptartment of Orthopedic Surgery, Children's Hospital of Wisconsin, 9000 W Wisconsin Avenue, PO Box 1997, Pediatric Orthopedics, Suite C360, Milwaukee, WI 53201, USA.
| | - Channing Tassone
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Deptartment of Orthopedic Surgery, Children's Hospital of Wisconsin, 9000 W Wisconsin Avenue, PO Box 1997, Pediatric Orthopedics, Suite C360, Milwaukee, WI 53201, USA
| | - John Thometz
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Deptartment of Orthopedic Surgery, Children's Hospital of Wisconsin, 9000 W Wisconsin Avenue, PO Box 1997, Pediatric Orthopedics, Suite C360, Milwaukee, WI 53201, USA
| | - Sergey Tarima
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Division of Biostatistics, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Quasi-automatic 3D reconstruction of the full spine from low-dose biplanar X-rays based on statistical inferences and image analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:658-664. [PMID: 30382429 DOI: 10.1007/s00586-018-5807-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/24/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To design a quasi-automated three-dimensional reconstruction method of the spine from biplanar X-rays as the daily used method in clinical routine is based on manual adjustments of a trained operator and the reconstruction time is more than 10 min per patient. METHODS The proposed method of 3D reconstruction of the spine (C3-L5) relies first on a new manual input strategy designed to fit clinicians' skills. Then, a parametric model of the spine is computed using statistical inferences, image analysis techniques and fast manual rigid registration. RESULTS An agreement study with the clinically used method on a cohort of 57 adolescent scoliotic subjects has shown that both methods have similar performance on vertebral body position and axial rotation (null bias in both cases and standard deviation of signed differences of 1 mm and 3.5° around, respectively). In average, the solution could be computed in less than 5 min of operator time, even for severe scoliosis. CONCLUSION The proposed method allows fast and accurate 3D reconstruction of the spine for wide clinical applications and represents a significant step towards full automatization of 3D reconstruction of the spine. Moreover, it is to the best of our knowledge the first method including also the cervical spine. These slides can be retrieved under electronic supplementary material.
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Abstract
STUDY DESIGN A prospective radiographic analysis of cervical spondylotic myelopathy (CSM). OBJECTIVE The aim of this study was to clarify the pathophysiology of CSM, and use the characteristic of global spinal alignment for determining the surgical strategy. SUMMARY OF BACKGROUND DATA Radiographic evaluation of CSM, in general, comprises cervical magnetic resonance imaging (MRI) and regional cervical radiography, which cannot distinguish between cervical hyperlodorsis with spinopelvic compensation and cervical lordorsis with normal global alignment. METHODS Our inclusion criteria were preoperative whole spine radiography and cervical MRI and health-related quality of life scores. Global spinal alignment was characterized by cervical lordosis (CL), C7 sagittal vertical axis (SVA), T1 slope (T1S), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and knee flexion angle (KFA). Cervical alignment was characterized by O-C2, C2-4, C5-7, and C2-7 angles; cranial center of gravity (CCG) C7SVA; and C2-7 SVA. Responsible lesion determined using MRI was divided from C2/3 to C7/T1. RESULTS Eighty-eight surgically treated CSM patients with EOS full spine imaging were prospectively analyzed. There were 72 normal (Type 1; SVA <50 mm) and 16 positive (Type 2; SVA ≥50 mm) global balance patients. There were significant differences in age, T1S, KFA, T1S-CL, SVA, CCG-SVA, and C2-7 SVA between Type 1 and Type 2. C3/4 lesion was more common in Type 2 than in Type 1. There was a positive correlation between global sagittal, but not regional, balance, and responsible lesion. C3/4 lesion was more frequent in older, male, high SVA, large T1S-CL, large KFA, and large cranial lordosis (C2-4/C5-7 angle) patients. CONCLUSION This study indicates the necessity for global alignment evaluation, particularly in older CSM patients because of their compensation mechanism for global malalignment. Surgical strategy for cranial type CSM should be carefully selected considering global balance. LEVEL OF EVIDENCE 4.
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Melhem E, Assi A, El Rachkidi R, Ghanem I. EOS(®) biplanar X-ray imaging: concept, developments, benefits, and limitations. J Child Orthop 2016; 10:1-14. [PMID: 26883033 PMCID: PMC4763151 DOI: 10.1007/s11832-016-0713-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/22/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In 1992, Georges Charpak invented a new type of X-ray detector, which in turn led to the development of the EOS(®) 2D/3D imaging system. This system takes simultaneous anteroposterior and lateral 2D images of the whole body and can be utilized to perform 3D reconstruction based on statistical models. The purpose of this review is to present the state of the art for this EOS(®) imaging technique, to report recent developments and advances in the technique, and to stress its benefits while also noting its limitations. METHODS The review was based on a thorough literature search on the subject as well as personal experience gained from many years of using the EOS(®) system. RESULTS While EOS(®) imaging could be proposed for many applications, it is most useful in relation to scoliosis and sagittal balance, due to its ability to take simultaneous orthogonal images while the patient is standing, to perform 3D reconstruction, and to determine various relationships among adjacent segments (cervical spine, pelvis, and lower limbs). The technique has also been validated for the study of pelvic and lower-limb deformity and pathology in adult and pediatric populations; in such a study it has the advantage of allowing the measurement of torsional deformity, which classically requires a CT scan. CONCLUSIONS The major advantages of EOS(®) are the relatively low dose of radiation (50-80 % less than conventional X-rays) that the patient receives and the possibility of obtaining a 3D reconstruction of the bones. However, this 3D reconstruction is not created automatically; a well-trained operator is required to generate it. The EOS(®) imaging technique has proven itself to be a very useful research and diagnostic tool.
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Affiliation(s)
- Elias Melhem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
| | - Rami El Rachkidi
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon
| | - Ismat Ghanem
- Department of Orthopaedic Surgery, Hôtel-Dieu de France Hospital, University of Saint Joseph, Boulevard Alfred Naccache, Achrafieh, P.O. Box 166830, Beirut, Lebanon ,Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint Joseph, Beirut, Lebanon
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Upright Biplanar Slot Scanning in Pediatric Orthopedics: Applications, Advantages, and Artifacts. AJR Am J Roentgenol 2015; 205:W124-32. [DOI: 10.2214/ajr.14.14022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Relevance of using a compressive preload in the cervical spine: an experimental and numerical simulating investigation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25 Suppl 1:S155-65. [DOI: 10.1007/s00590-015-1625-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
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Meijer MF, Boerboom AL, Stevens M, Bulstra SK, Reininga IHF. Assessment of prosthesis alignment after revision total knee arthroplasty using EOS 2D and 3D imaging: a reliability study. PLoS One 2014; 9:e104613. [PMID: 25247714 PMCID: PMC4172435 DOI: 10.1371/journal.pone.0104613] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/15/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction A new low-dose X-ray device, called EOS, has been introduced for determining lower-limb alignment in 2D and 3D. Reliability has not yet been assessed when using EOS on lower limbs containing a knee prosthesis. Therefore purpose of this study was to determine intraobserver and interobserver reliability of EOS 2D and 3D knee prosthesis alignment measurements after revision total knee arthroplasty (rTKA). Methods Forty anteroposterior and lateral images of 37 rTKA patients were included. Two observers independently performed measurements on these images twice. Varus/valgus angles were measured in 2D (VV2D) and 3D (VV3D). Intraclass correlation coefficients and the Bland and Altman method were used to determine reliability. T-tests were used to test potential differences. Results Intraobserver and interobserver reliability were excellent for VV2D and VV3D. No significant difference or bias between the first and second measurements or the two observers was found. A significant mean and absolute difference of respectively 1.00° and 1.61° existed between 2D and 3D measurements. Conclusions EOS provides reliable varus/valgus measurements in 2D and 3D for the alignment of the knee joint with a knee prosthesis. However, significant differences exist between varus/valgus measurements in 2D and 3D.
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Affiliation(s)
- Marrigje F. Meijer
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Gronigen, The Netherlands
- * E-mail:
| | - Alexander L. Boerboom
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Gronigen, The Netherlands
| | - Martin Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Gronigen, The Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Gronigen, The Netherlands
| | - Inge H. F. Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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A new approach to corpus callosum anomalies in idiopathic scoliosis using diffusion tensor magnetic resonance imaging. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:2643-9. [DOI: 10.1007/s00586-014-3435-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/21/2014] [Accepted: 06/21/2014] [Indexed: 11/25/2022]
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Clarke IC, Lazennec JY, Brusson A, Savisaar C, Bowsher JG, Burgett M, Donaldson TK. Risk of impingement and third-body abrasion with 28-mm metal-on-metal bearings. Clin Orthop Relat Res 2014; 472:497-508. [PMID: 24297107 PMCID: PMC3890183 DOI: 10.1007/s11999-013-3399-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concerns have been raised about the sequelae of metal-on-metal (MoM) bearings in total hip arthroplasty (THA). However, retrieval studies, which offer the best insight into the clinically relevant mechanisms of MoM wear, have followed predictable trends to date such as indicting cobalt-chromium (CoCr) metallurgy, cup design, high conformity between the head and cup, "steep cups," "microseparation," and "edge wear." QUESTIONS/PURPOSES We wished to evaluate a set of retrieved 28-mm MoM THA for signs of (1) cup-to-stem impingement; (2) normal wear pattern and concomitant stripe damage on femoral heads that would signify adverse wear mechanics; and (3) well-defined evidence of third-body scratches on bearings that would indicate large abrasive particles had circulated the joint space. METHODS Ten 28-mm MOM retrievals were selected on the basis that femoral stems were included. Revision surgeries at 3 to 8 years were for pain, osteolysis, and cup loosening. CoCr stems and the MoM bearings were produced by one vendor and Ti6Al4V stems by a second vendor. All but two cases had been fixed with bone cement. We looked for patterns of normal wear and impingement signs on femoral necks and cup rims. We looked for adverse wear defined as stripe damage that was visually apparent on each bearing. Wear patterns were examined microscopically to determine the nature of abrasions and signs of metal transfer. Graphical models recreated femoral neck and cup designs to precisely correlate impingement sites on femoral necks to cup positions and head stripe patterns. RESULTS The evidence revealed that all CoCr cup liners had impinged on either anterior or posterior facets of femoral necks. Liner impingement at the most proximal neck notch occurred with the head well located and impingement at the distal notch occurred with the head rotated 5 mm out of the cup. The hip gained 20° motion by such a subluxation maneuver with this THA design. All heads had stripe wear, the basal and polar stripes coinciding with cup impingement sites. Analysis of stripe damage revealed 40 to 100-μm wide scratches created by large particles ploughing across bearing surfaces. The association of stripe wear with evidence of neck notching implicated impingement as the root cause, the outcome being the aggressive third-body wear. CONCLUSIONS We found consistent evidence of impingement, abnormal stripe damage, and evidence of third-body abrasive wear in a small sample of one type of 28-mm MoM design. Impingement models demonstrated that 28-mm heads could lever 20° out of the liners. Although other studies continue to show good success with 28-mm MoM bearings, their use has been discontinued at La Pitie Hospital.
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Affiliation(s)
- Ian C. Clarke
- Department of Orthopaedics, Loma Linda University, Loma Linda, CA USA ,DARF Center, 900E Washington Street #200, Colton, CA 92324 USA
| | - Jean-Yves Lazennec
- Department of Orthopaedics, La Pitie Hospital, UPMC University, Paris, France
| | - Adrien Brusson
- Department of Orthopaedics, La Pitie Hospital, UPMC University, Paris, France
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Little J, Adam C. Geometric sensitivity of patient-specific finite element models of the spine to variability in user-selected anatomical landmarks. Comput Methods Biomech Biomed Engin 2013; 18:676-88. [DOI: 10.1080/10255842.2013.843673] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Three-dimensional imaging of the spine using the EOS system: is it reliable? A comparative study using computed tomography imaging. J Pediatr Orthop B 2013; 22:409-12. [PMID: 23652967 DOI: 10.1097/bpb.0b013e328361ae5b] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The aim of this study was to evaluate the precision of three-dimensional geometry compared with computed tomography (CT) images. This retrospective study included patients who had undergone both imaging of the spine using the EOS imaging system and CT scanning of the spine. The apical vertebral orientation was also measured using the EOS imaging system and by CT. Other measures such as the Cobb angle and apical vertebral rotation and translation were used as the control variables to evaluate the potential discrepancy between the standing position in EOS imaging and the supine position in CT scanning. The apical vertebral orientations were 8.7° for the first measurement and 8.4° for the second measurement made by the first author, and 10.3° for the measurement made by the second author. The average of these measurements was 9.3° compared with 6.6° (P=0.65) obtained on CT scanning. The precision of EOS-based measurements of vertebral rotation has never been tested in clinical practice. Although it has limitations, this study suggests that the results obtained using EOS are comparable to those obtained on CT.
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Rousseau MA, Brusson A, Lazennec JY. Assessment of the axial rotation of the pelvis with the EOS® imaging system: intra- and inter-observer reproducibility and accuracy study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:891-5. [DOI: 10.1007/s00590-013-1281-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/03/2013] [Indexed: 12/01/2022]
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Somoskeöy S, Tunyogi-Csapó M, Bogyó C, Illés T. Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Spine J 2012; 12:1052-9. [PMID: 23102842 DOI: 10.1016/j.spinee.2012.10.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 07/16/2012] [Accepted: 10/01/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Three-dimensional (3D) deformations of the spine are predominantly characterized by two-dimensional (2D) angulation measurements in coronal and sagittal planes, using anteroposterior and lateral X-ray images. For coronal curves, a method originally described by Cobb and for sagittal curves a modified Cobb method are most widely used in practice, and these methods have been shown to exhibit good-to-excellent reliability and reproducibility, carried out either manually or by computer-based tools. Recently, an ultralow radiation dose-integrated radioimaging solution was introduced with special software for realistic 3D visualization and parametric characterization of the spinal column. PURPOSE Comparison of accuracy, correlation of measurement values, intraobserver and interrater reliability of methods by conventional manual 2D and sterEOS 3D measurements in a routine clinical setting. STUDY DESIGN/SETTING Retrospective nonrandomized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009. PATIENT SAMPLE In total, 201 individuals (170 females, 31 males; mean age, 19.88 years) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis (175 cases), adult degenerative scoliosis (11 cases), and Scheuermann hyperkyphosis (5 cases). Overall range of coronal curves was between 2.4° and 117.5°. Analysis of accuracy and reliability of measurements were carried out on a group of all patients and in subgroups based on coronal plane deviation: 0° to 10° (Group 1, n=36), 10° to 25° (Group 2, n=25), 25° to 50° (Group 3, n=69), 50° to 75° (Group 4, n=49), and more than 75° (Group 5, n=22). METHODS Coronal and sagittal curvature measurements were determined by three experienced examiners, using either traditional 2D methods or automatic measurements based on sterEOS 3D reconstructions. Manual measurements were performed three times, and sterEOS 3D reconstructions and automatic measurements were performed two times by each examiner. Means comparison t test, Pearson bivariate correlation analysis, reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software (IBM Corp., Armonk, NY, USA). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. RESULTS In comparison with manual 2D methods, only small and nonsignificant differences were detectable in sterEOS 3D-based curvature data. Intraobserver reliability was excellent for both methods, and interrater reproducibility was consistently higher for sterEOS 3D methods that was found to be unaffected by the magnitude of coronal curves or sagittal plane deviations. CONCLUSIONS This is the first clinical report on EOS 2D/3D system (EOS Imaging, Paris, France) and its sterEOS 3D software, documenting an excellent capability for accurate, reliable, and reproducible spinal curvature measurements.
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Affiliation(s)
- Szabolcs Somoskeöy
- Department of Orthopedic Surgery, Institute of Musculoskeletal Surgery, University of Pécs Clinical Center, 1 Akác utca, Pécs H-7632, Hungary.
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Somoskeöy S, Tunyogi-Csapó M, Bogyó C, Illés T. Clinical validation of coronal and sagittal spinal curve measurements based on three-dimensional vertebra vector parameters. Spine J 2012; 12:960-8. [PMID: 23018164 DOI: 10.1016/j.spinee.2012.08.175] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 02/13/2012] [Accepted: 08/25/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT For many decades, visualization and evaluation of three-dimensional (3D) spinal deformities have only been possible by two-dimensional (2D) radiodiagnostic methods, and as a result, characterization and classification were based on 2D terminologies. Recent developments in medical digital imaging and 3D visualization techniques including surface 3D reconstructions opened a chance for a long-sought change in this field. Supported by a 3D Terminology on Spinal Deformities of the Scoliosis Research Society, an approach for 3D measurements and a new 3D classification of scoliosis yielded several compelling concepts on 3D visualization and new proposals for 3D classification in recent years. More recently, a new proposal for visualization and complete 3D evaluation of the spine by 3D vertebra vectors has been introduced by our workgroup, a concept, based on EOS 2D/3D, a groundbreaking new ultralow radiation dose integrated orthopedic imaging device with sterEOS 3D spine reconstruction software. PURPOSE Comparison of accuracy, correlation of measurement values, intraobserver and interrater reliability of methods by conventional manual 2D and vertebra vector-based 3D measurements in a routine clinical setting. STUDY DESIGN Retrospective, nonrandomized study of diagnostic X-ray images created as part of a routine clinical protocol of eligible patients examined at our clinic during a 30-month period between July 2007 and December 2009. PATIENT SAMPLE In total, 201 individuals (170 females, 31 males; mean age, 19.88 years) including 10 healthy athletes with normal spine and patients with adolescent idiopathic scoliosis (175 cases), adult degenerative scoliosis (11 cases), and Scheuermann hyperkyphosis (5 cases). Overall range of coronal curves was between 2.4 and 117.5°. Analysis of accuracy and reliability of measurements was carried out on a group of all patients and in subgroups based on coronal plane deviation: 0 to 10° (Group 1; n=36), 10 to 25° (Group 2; n=25), 25 to 50° (Group 3; n=69), 50 to 75° (Group 4; n=49), and above 75° (Group 5; n=22). METHODS All study subjects were examined by EOS 2D imaging, resulting in anteroposterior (AP) and lateral (LAT) full spine, orthogonal digital X-ray images, in standing position. Conventional coronal and sagittal curvature measurements including sagittal L5 vertebra wedges were determined by 3 experienced examiners, using traditional Cobb methods on EOS 2D AP and LAT images. Vertebra vector-based measurements were performed as published earlier, based on computer-assisted calculations of corresponding spinal curvature. Vertebra vectors were generated by dedicated software from sterEOS 3D spine models reconstructed from EOS 2D images by the same three examiners. Manual measurements were performed by each examiner, thrice for sterEOS 3D reconstructions and twice for vertebra vector-based measurements. Means comparison t test, Pearson bivariate correlation analysis, reliability analysis by intraclass correlation coefficients for intraobserver reproducibility and interrater reliability were performed using SPSS v16.0 software. RESULTS In comparison with manual 2D methods, only small and nonsignificant differences were detectable in vertebra vector-based curvature data for coronal curves and thoracic kyphosis, whereas the found difference in L1-L5 lordosis values was shown to be strongly related to the magnitude of corresponding L5 wedge. Intraobserver reliability was excellent for both methods, and interrater reproducibility was consistently higher for vertebra vector-based methods that was also found to be unaffected by the magnitude of coronal curves or sagittal plane deviations. CONCLUSIONS Vertebra vector-based angulation measurements could fully substitute conventional manual 2D measurements, with similar accuracy and higher intraobserver reliability and interrater reproducibility. Vertebra vectors represent a truly 3D solution for clear and comprehensible 3D visualization of spinal deformities while preserving crucial parametric information for vertebral size, 3D position, orientation, and rotation. The concept of vertebra vectors may serve as a starting point to a valid and clinically useful alternative for a new 3D classification of scoliosis.
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Affiliation(s)
- Szabolcs Somoskeöy
- Department of Orthopedic Surgery, Institute of Musculoskeletal Surgery, University of Pécs Clinical Center, 1 Akác utca, Pécs, Hungary H-7632.
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Guenoun B, Zadegan F, Aim F, Hannouche D, Nizard R. Reliability of a new method for lower-extremity measurements based on stereoradiographic three-dimensional reconstruction. Orthop Traumatol Surg Res 2012; 98:506-13. [PMID: 22858107 DOI: 10.1016/j.otsr.2012.03.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/05/2012] [Accepted: 03/12/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Several clinical and radiological techniques have been described to assess lower limb length and angle measurements. None of them has yet met the ideal criteria for a reliable, reproducible, safe, and inexpensive system. In this context, a new biplanar X-ray system (EOS™, EOS imaging, Paris, France) makes it possible to obtain a 3D reconstruction of the lower extremities from two 2D orthogonal radiographic images, with associated calculation of 3D measurements. The reliability of this technique has never been documented on adults. HYPOTHESIS Lower limb measurements produced by the 3D EOS™ reconstruction system are reproducible regarding inter- and intraobserver assessment and more reliable with this 3D technique than when they are obtained from 2D measurements. MATERIALS AND METHODS This study included 25 patients awaiting total hip arthroplasty (50 lower limbs). Two independent observers made all measurements twice, both on the 2D frontal radiograph and using 3D reconstructions (femoral measurements of length, offset, neck shaft angle, neck length, and head diameter, as well as the tibia length, limb length, HKA and HKS). Reproducibility was estimated by intraclass correlation coefficients. RESULTS Both the inter- and intraobserver reproducibility of the EOS™ measurements was excellent; more specifically inter- and intraobserver reproducibility was 0.997 and 0.997 for femoral length, 0.996 and 0.995 for tibial length, 0.999 and 0.999 for limb length, 0.894 and 0.891 for HKS, 0.993 and 0.994 for HKA, 0.870 and 0.845 for femoral offset, and 0.765 and 0.851 for neck shaft angle. For most of the variables, the interobserver correlations were statistically better with the EOS™ 3D reconstruction. DISCUSSION Our results show that the EOS™ systems allow reproducible lower limb measurements. Furthermore, 3D EOS™ reconstructions offer better reproducible measures for most of the parameters than radiographic 2D projection. Its use before deciding on surgery and during planning for lower limb arthroplasty appears essential to us. LEVEL OF EVIDENCE Level III: diagnostic prospective study on consecutive patients.
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Affiliation(s)
- B Guenoun
- Department of Orthopedic and traumatology Surgery A, Cochin, Port-Royal Hospital Group (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75679 Paris, France.
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Barrey C, Champain S, Campana S, Ramadan A, Perrin G, Skalli W. Sagittal alignment and kinematics at instrumented and adjacent levels after total disc replacement in the cervical spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:1648-59. [PMID: 22331142 DOI: 10.1007/s00586-012-2180-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 10/02/2011] [Accepted: 01/28/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of the study was to report radiological outcomes after total disc replacement (TDR) in the cervical spine through a 24 months follow-up (FU) prospective study with a special focus on sagittal alignment and kinematics at instrumented and adjacent levels. MATERIALS AND METHODS Thirty-two patients, who sustained one-level TDR with a ball-and-socket arthroplasty (Discocerv(™) implant, Scient'x/Alphatec Spine, USA) were consecutively included in the study. Clinical (visual analogical scale and neck disability index) and radiological parameters were measured preoperatively and postoperatively at 3/6 months, 1-year and 2-year FU. Sagittal alignment, ranges of motion (ROM) and center of rotations (CORs) were analyzed using specific motion analysis software (Spineview(™), Paris, France). Patients CORs were compared with those of a control group of 39 normal and asymptomatic subjects. RESULTS Both local and C3-C7 lordosis significantly increased postoperatively (+8° and +13° at 2 years, respectively). At instrumented level ROM in flexion-extension (FE) was measured to 10.2° preoperatively versus 7.5° at 1 year and 6.1° at 2 years. There were no differences in ROM at adjacent levels between pre and postoperative assessments. When compared with control group and preoperative measurements, we noted postoperative cranial shift of the COR at instrumented level for patients group. In contrast, there was no difference in CORs location at adjacent levels. CONCLUSION Through this prospective study, we observed that cervical lordosis consistently increased after TDR. In addition, although ball-and-socket arthroplasty did not fully restore native segmental kinematics with significant reduction of motion in FE and consistent cranial shift of the COR, no significant changes in terms of ROM and CORs were observed at adjacent levels.
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Affiliation(s)
- Cédric Barrey
- Department of Spine Surgery, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, Lyon, France.
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Three-dimensional measurements of the lower extremity in children and adolescents using a low-dose biplanar X-ray device. Eur Radiol 2011; 22:765-71. [DOI: 10.1007/s00330-011-2308-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/23/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
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Rousseau MA, Laporte S, Dufour T, Steib JP, Lazennec JY, Skalli W. Three-dimensional assessment of the intervertebral kinematics after Mobi-C total disc replacement at the cervical spine in vivo using the EOS stereoradiography system. SAS JOURNAL 2011; 5:63-8. [PMID: 25802670 PMCID: PMC4365625 DOI: 10.1016/j.esas.2011.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Because 3-dimensional computed tomography and magnetic resonance imaging analysis of the spinal architecture is done with the patient in the supine position, stereoradiography may be more clinically relevant for the measurement of the relative displacements of the cervical vertebrae in vivo in the upright position. The innovative EOS stereoradiography system was used for measuring the relative angular displacements of the cervical vertebrae in a limited population to determine its feasibility. The precision and accuracy of the method were investigated. Methods In 9 patients with 16 Mobi-C prostheses (LDR Medical, Troyes, France) and 12 healthy subjects, EOS stereoradiography of the lower cervical spine (C3-7) was performed in the neutral upright position of the neck, flexion, extension, left and right lateral bending, and left and right axial rotation. The angular displacements were measured from the neutral position to every other posture. The random error was studied in terms of reproducibility. In addition, an in vitro protocol was performed in 6 specimens to investigate accuracy. Results The reproducibility and the accuracy variables varied similarly between 1.2° and 3.2° depending on the axis and direction of rotation under consideration. The Mobi-C group showed less mobility than the control group, whereas the pattern of coupling was similar. Conclusions Overall, the feasibility of dynamic EOS stereoradiography was shown. The prosthesis replicates the pattern of motion of the normal cervical spine.
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Affiliation(s)
- Marc-Antoine Rousseau
- Biomechanics Lab, Arts et Métiers ParisTech, Centre national de la recherche scientifique (CNRS), unités mixtes de recherche (UMR) 8005, Paris, France ; Department of Orthopaedic Surgery, Hôpital Pitié Salpétrière Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Sébastien Laporte
- Biomechanics Lab, Arts et Métiers ParisTech, Centre national de la recherche scientifique (CNRS), unités mixtes de recherche (UMR) 8005, Paris, France
| | - Thierry Dufour
- Department of Neurosurgery, Hôpital La Source, Orléans, France
| | - Jean-Paul Steib
- Department of Orthopaedic Surgery, Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Yves Lazennec
- Department of Orthopaedic Surgery, Hôpital Pitié Salpétrière Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Wafa Skalli
- Biomechanics Lab, Arts et Métiers ParisTech, Centre national de la recherche scientifique (CNRS), unités mixtes de recherche (UMR) 8005, Paris, France
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Cervical disc prosthesis versus arthrodesis using one-level, hybrid and two-level constructs: an in vitro investigation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:432-42. [PMID: 21833571 DOI: 10.1007/s00586-011-1974-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 07/31/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The purpose of this experimental study was to analyse cervical spine kinematics after 1-level and 2-level total disc replacement (TDR) and compare them with those after anterior cervical arthrodesis (ACA) and hybrid construct. Kinematics and intradiscal pressures were also investigated at adjacent levels. METHODS Twelve human cadaveric spines were evaluated in different testing conditions: intact, 1 and 2-level TDR (Discocerv™, Scient'x/Alphatec), 1 and 2-level ACA, and hybrid construct. All tests were performed under load control protocol by applying pure moments loading of 2 N m in flexion/extension (FE), axial rotation (AR) and lateral bending (LB). RESULTS Reduction of ROM after 1-level TDR was only significant in LB. Implantation of additional TDR resulted in significant decrease of ROM in AR at index level. A second TDR did not affect kinematics of the previously implanted TDR in FE, AR and LB. One and 2-level arthrodesis caused significant decrease of ROM in FE, AR and LB at the index levels. No significant changes in ROM were observed at adjacent levels except for 1-level arthrodesis in FE and hybrid construct in AR. When analysis was done under the displacement-control concept, we found that 1 and 2-constructs increased adjacent levels contribution to global ROMC3-C7 during FE and that IDP at superior adjacent level increased by a factor of 6.7 and 2.3 for 2-level arthrodesis and hybrid constructs, respectively. CONCLUSION Although 1- and 2-level TDR restored only partially native kinematics of the cervical spine, these constructs generated better biomechanical conditions than arthrodesis at adjacent levels limiting contribution of these segments to global ROM and reducing the amount of their internal stresses.
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Three-dimensional morphology and kinematics of the craniovertebral junction in rheumatoid arthritis. Spine (Phila Pa 1976) 2010; 35:E1278-84. [PMID: 20736886 DOI: 10.1097/brs.0b013e3181e6d578] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case-series study. OBJECTIVES To measure the 3-dimensional (3D) morphology and kinematics of the craniovertebral junction (CVJ) using a 3D computed tomography (CT) model; to reveal abnormal patterns and the relationships between pathology and kinematics. SUMMARY OF BACKGROUND DATA Evaluations using radiography, 2-dimensional (2D) CT and magnetic resonance imaging have limitations because of the complex 3D structure of the CVJ. METHODS Twenty-four rheumatoid arthritis patients (21 females, 3 males) with cervical involvement underwent CT scanning of the cervical spine from the basilar process of the occipital bone to the first thoracic vertebra in neutral and flexed positions. The 3D morphology of the occipital condyle, atlas, and axis were classified based on the type of deformity observed. Periodontoid lesions (continuous bony lesions between the atlas and the odontoid process) were also noted. The 3D kinematics in the atlanto-occipital and atlantoaxial joints were evaluated using the volume merge method. RESULTS Deformities in the atlanto-occipital joints appeared more frequently than those in the atlantoaxial joints. The most common instability pattern was flexural rotation during flexion at the CVJ. The direction of translational motions during flexion was posterior in the atlanto-occipital joint and anterior and caudal in the atlantoaxial joint. CONCLUSION The results suggest that bilateral occipital condyle deformation, unilateral and bilateral mass collapse, and periodontoid lesions may affect flexion/extension rotational instability in the atlantoaxial joint. In addition, unilateral occipital condyle deformation and atlantoaxial joint stability may affect sagittal translational instability to the posterior side in the atlanto-occipital joint. The noninvasive 3D CT imaging technique employed here would be useful for predicting the prognosis of patients with rheumatoid deformities at the CVJ.
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Shoulder bony landmarks location using the EOS® low-dose stereoradiography system: a reproducibility study. Surg Radiol Anat 2009; 32:153-8. [DOI: 10.1007/s00276-009-0566-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/19/2009] [Indexed: 10/20/2022]
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Laville A, Laporte S, Skalli W. Parametric and subject-specific finite element modelling of the lower cervical spine. Influence of geometrical parameters on the motion patterns. J Biomech 2009; 42:1409-1415. [PMID: 19442980 DOI: 10.1016/j.jbiomech.2009.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 04/06/2009] [Accepted: 04/06/2009] [Indexed: 11/29/2022]
Abstract
Morphometrical and postural features of the cervical spine are supposed to significantly influence its biomechanical behaviour. However, the effects of these geometrical parameters are quite difficult to evaluate. An original numerical method is proposed in order to automatically generate parametric and subject-specific meshes of the lower cervical spine. Sixteen finite element models have been built from cadaver specimens using low dose biplanar X-rays. All the generated meshes fulfilled the quality criteria. A preliminary evaluation was performed on the C5-C6 functional units using a database of previous experimental tests. The principal and coupled motions were simulated. The responses of the numerical models were within the experimental standard deviation corridors in most cases. Rotation-moment relationships were then compared to assess the influence of geometry on the mechanical response. Geometry was found to play a significant role in the motion patterns.
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Affiliation(s)
- A Laville
- Arts et Metiers ParisTech, CNRS, LBM, 151 bd de l'Hopital, 75013 Paris, France; Institut de Médecine Aérospatiale du Service de Santé des Armées, Bretigny Sur Orge, France.
| | - S Laporte
- Arts et Metiers ParisTech, CNRS, LBM, 151 bd de l'Hopital, 75013 Paris, France.
| | - W Skalli
- Arts et Metiers ParisTech, CNRS, LBM, 151 bd de l'Hopital, 75013 Paris, France
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